Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 5101020900 | MI |
NPI | 1003231861 |
---|---|
Provider Name | Michael Conrad Weber |
First Address | Detroit, MI 48201 |
Second Address | San Diego, CA 92134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2014 |
Last Update Date | 27/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VADOOO | (05) | MI |